Oostenbrink et al developed risk score based on clinical and laboratory findings to evaluate children with meningeal signs. This can help determine which children need a lumbar puncture and which can be spared the procedure. The authors are from the University of Utrecht in The Netherlands.
Parameters:
(1) duration of complaints in days
(2) vomiting
(3) signs of meningeal irritation
(4) cyanosis
(5) petechiae
(6) disturbed consciousness (reaction to pain only or no reaction at all)
(7) serum C-reactive protein (CRP)
Parameter |
Finding |
Points |
---|---|---|
duration of complaints in days |
|
(number of days, as a whole number) |
vomiting |
yes |
1 |
|
no |
0 |
signs of meningeal irritation |
yes |
1 |
|
no |
0 |
cyanosis |
yes |
1 |
|
no |
0 |
petechiae |
yes |
1 |
|
no |
0 |
disturbed consciousness |
yes |
1 |
|
no |
0 |
serum CRP in mg/L |
|
MIN(2, 0.1*ROUNDDOWN(CRP/10,0)) |
where:
• CRP is graded 0 points for 0-9 mg/L, 0.1 points for 10-19 mg/L etc, up to maximum 2 points (Table 3, page 615, Oostenbrink et al, 2001)
• Signs of meningeal irritation for children <= 1 year included: bulging fontanella, irritability during the examination, Brudzinki sign, Kernig sign, tripod phenomenon, or neck stiffness.
• Signs of meningeal irritation for children > 1 year included: neck pain, Brudzinki sign, Kernig sign, tripod phenomenon, or neck stiffness.
total score =
= (points for duration of complaints) + (2 * (points for vomiting)) + (7.5 * (points for meningeal irritation)) + (6.5 * (points for cyanosis)) + (4 * (points for petechiae)) + (8 * (points for disturbed consciousness)) + (points for CRP)
Interpretation:
• minimum score: 0.5
• maximum score: 31
• The risk of bacterial meningitis was considered highly unlikely if the total score is < 9.5.
• The risk of bacterial meningitis was 44% for a score >= 9.5. Those with a higher score have a higher risk.
Total Score |
Rate of Bacterial Meningitis |
---|---|
< 9.5 |
0% |
9.5 – 14.9 |
15-16% |
15.0 – 19.9 |
44-63% |
>= 20 |
73-98% |
from Table 4, page 615, Oostenbrink, 2001
Performance:
• The area under the ROC curve was 0.95.
Purpose: To determine the risk of bacterial meningitis in a child with meningeal symptoms using the risk score of Oostenbrink et al.
Specialty: Infectious Diseases, Neurology
Objective: risk factors, clinical diagnosis, including family history for genetics, severity, prognosis, stage
ICD-10: G00,